What are the responsibilities and job description for the Professional Coder-Certified position at Centers For Pain Control?
PURPOSE:
Reporting to the Billing Team Supervisor, the professional coder is responsible for reviewing clinical documentation to abstract and/or validate CPT and ICD-10 coding for office based and outpatient professional services.
ACCOUNTABILITIES AND JOB ACTIVITIES:
Ensure that medical coders are trained, knowledgeable and consistently adhering to key responsibilities relevant to job description
Train new employees
Perform ongoing training and education as needed
Conduct audits to ensure the accuracy of the coding team and re-train and/or initiate coaching if necessary
Monitor daily workload to ensure that claims are created in a timely manner
Ensure that professional and facility service claims are created on a daily basis without interruption
Responsible for alerting proper parties if any interruptions are discovered
Analyze office progress notes, procedural and operative records to identify and independently assign accurate ICD and CPT/HCPCS codes while adhering to ICD-10-CM, CPT and all appropriate government coding guidelines, in addition to adhering to all CPC/IPM coding/billing policies and procedures
Resolve coding related edits in the AthenaOne practice management system by applying the aforementioned rules, policies and procedures
Abstract pertinent information into the billing system accurately and timely
Maintain compliance with Federal, State and Payer regulations
Serve as a subject matter expert to the coding team and clinicians as needed
Keep abreast of current coding changes, documentation requirements and payer policies within designated specialties
Demonstrate the ability to educate/train coding staff, physicians and mid-level providers as needed
Assist with coding denials received from payers
Identify denial trends and educate the coding team and/or request system edits as needed
Appeal claims as needed and assist with the development of letters of medical necessity as required
Assist with charge capture initiatives by monitoring services performed to assure all encounters are captured, coded and billed within timeframes established by CPC/IPM
Monitor all AthenaOne claim worklists to ensure that charges are being worked in a timely fashion and alert management team as needed if any concerns are identified
Attend meetings and training sessions virtually or by traveling to provider and business locations as needed
Develop and maintain personal and professional skills
Attend all mandatory staff meetings per year unless excused as evidenced by documentation
Attend mandatory in-services and a minimum of two pertinent in-services per year as documented
Actively participate in performance improvement activities as observed or documented
Establish realistic professional goals as evidenced by the annual performance evaluation
Actively keep abreast of departmental and organizational activities
Demonstrate flexibility in response to unexpected change in workload or situations as observed
Serve on committees and/or participates in changes of policy and procedures that affect the revenue cycle
Assist in the orientation of new personnel as directed
Support the mission and goals of the company as observed
Address all emails within 24 hours as documented
Perform other duties as required
Demonstrate safe and cost-effective practice
Consistently adhere to OSHA bloodborne pathogen guidelines; apply universal precautions per company standards as observed
Consistently utilize proper body mechanics as observed
Accurately complete incident reports within the shift of occurrence and immediately communicates critical incidents to the appropriate person per the organizational chart
Consistently allocate resources to reduce waste and minimize costs as observed
- Consistently complete assigned duties within stated shifts in a timely manner as observed and documented
BEHAVIORAL EXPECTATIONS
Strive for excellence
Set challenging goals
Produce quality work in a timely fashion
Maintain current knowledge and skill
Participate in quality and process improvement efforts
Keep the work area clean, safe and secure
Act Flexibly
Adapt to change
See the value of different opinions and new ideas
Change plans and objectives given new direction or priorities
Handle stressful situations effectively
Meet Customer Needs
Meet internal and external customers’ needs
Find new ways of satisfying customers
Participate in service improvements efforts
Listen and respond to customers
Treat customers with compassion and respect
Work as a Team
Work as a team player
Pitch in to help those in need
Communicate with others appropriately
Listen and respond to others
Handle conflict situations effectively
Foster trust and respect within the team
Participate in committees and task forces
Foster Diversity in the Workforce
Treat all associates and customers with respect, integrity and dignity regardless of background, race, age, gender, gender identity, sexual orientation, religion or disability
Treat all associates and customers fairly
Be Self-directed
Take initiative and responsibility for actions
Identify own learning needs and create/implement Learning Plans
Perform duties according to policies and procedures
Demonstrate ethical behaviors
Maintain confidentiality of information
Maintain licenses and certifications as appropriate
Fulfill operating unit/clinical competencies
Use equipment/resources responsibly
You must refer to upper management for approval or final disposition on the following
Change in procedure
Difficult patient situations
Any situation you are unsure of
JOB REQUIREMENTS
COMPETENT LEVEL QUALIFICATIONS
MINIMUM LEVEL QUALIFICATIONS
SKILLS
(Typing and special machinery)
Knowledge of Electronic Medical Record
- Good typing skills
- Good internet navigation skills
Knowledge of instrumentation used in office (fax, credit card, copy)
- Knowledge of multi-line phone system
- Excellent Verbal and Written Communication skills
- Knowledge of medical terminology with a strong focus on the spine and skeletal system.
- Advanced knowledge and skill in CPT, ICD-10-CM and HCPCS code assignment
- Knowledge of federal, state, and payer-specific regulations and policies pertaining to documentation, coding, and billing, with demonstrated ability to interpret such guidelines
- 5 years of experience with research, analyze, interpret, and abstract data/documentation
- Ability to collaborate with cross functional teams and departments
- Good problem-solving skills
EDUCATION AND EXPERIENCE (Degrees, years in profession)
Certified Professional Coder (CPC) or Certified Coding Specialist-Physician based (CCS-P) preferred
High School diploma or equivalent
- 5 years of professional coding experience in a physician practice setting.
- 2 years of current direct supervisory experience as a Billing/Coding/Reimbursement Supervisor with assigned direct reports
- 5 years of experience with ICD-10, CPT and HCPCS.
- 5 years of experience in medical terminology.
- 5 years of experience of Explanation of Benefits and CMS 1500 form.
Special Job Characteristics
- Fast paced work environment with established time constraints
- Must be able to work overtime when required
- Must be able to multitask while maintaining accuracy
- Must work well with others